Provider Enrollment Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Collaborate with the Provider Enrollment Manager to identify issues or denials related to provider payer enrollment.

• Investigate and resolve payer enrollment challenges using both proprietary and external resources.

• Communicate with clients, operations staff, CMS, and various payers via phone, email, or online platforms.

• Coordinate with market locations to investigate and address payer enrollment concerns.

• Prepare and submit applications for CMS Medicare, State Medicaid, and third-party payers.

• Monitor and follow up to ensure the establishment of provider numbers and their association with the relevant client group entities and software systems.

• Keep documentation and reporting updated for ongoing payer enrollments.

• Maintain records of completed CMS applications.

• Develop effective working relationships with clients, Operations, and Revenue Cycle Management teams.

• Acquire, monitor, and manage payer revalidation dates; submit and track applications to ensure continuous active enrollment and avoid deactivation.

• Update provider demographics in relevant enrollment systems.

• Add providers to relevant systems and ensure information is managed so that claims are either held or released based on their enrollment status.

• Execute special projects and other assigned tasks.

⛳️ Requirements

• An Associate's degree (2 years) is required.

• A Bachelor's degree in a related field is preferred.

• At least one (1) year of experience in provider enrollment is preferred.

• Familiarity with application requirements for CMS, State Medicaid, and third-party payers is essential.

• Understanding of prerequisites, required forms, completion guidelines, supporting documentation, and relevant regulations.

• Proficiency in physician HIPAA Privacy & Security policies and procedures.

• Excellent oral, written, and interpersonal communication abilities.

• Proficient in word processing, spreadsheet, database, and presentation software.

• Strong attention to detail, analytical, decision-making, problem-solving, organizational, and time management skills.

• Capability to complete and verify complex enrollment packages.

• Ability to work independently as well as collaboratively in a team-oriented, fast-paced environment.

• Must maintain strict confidentiality concerning protected provider and health information.

• Proficient in troubleshooting, taking initiative, exercising sound judgment, and handling sensitive information appropriately.

🏝️ Benefits

• Performance-based incentive plan.

• Discretionary incentive bonus.

• Referral bonus.

• Remote work arrangement.